Foot Progression Angle in Individuals with Diabetes & Peripheral Neuropathy

描述(申请人提供)：这项研究的长期目标是确定足部推进角(FPA)在糖尿病和周围神经病变(DMPN)成人神经病理性足底溃疡(DMPN)发生中的作用。临床意义：在美国，每年大约有8万例非创伤性下肢截肢，其中84%是神经性足底溃疡。患有DMPN的成年人是神经性足底溃疡的高危人群，继发于无知觉的足部骨质隆起下的足底压力峰值升高。因此，足底峰值压力经常被用作皮肤破裂和随后的非创伤性下肢截肢风险的替代测量。初步研究表明，在患有神经病理的儿童和患有DMPN的成人中，过多的外部FPA与足底内侧峰值压力的时间和幅度有直接关系。鉴于成人DMPN患者的功能活动障碍发生率是健康成人患者的近3倍，我们有必要更好地理解过多的外部FPA在足底内侧峰值压力过高、内侧神经性足底溃疡和非创伤性下肢截肢等损害级联中的作用。未探索的研究领域：尽管过高的外部FPA与足底压力之间存在密切关系，但据我们所知，还没有研究探讨导致DMPN患者FPA的关节活动限制。此外，还没有研究探讨是否可以减少成人DMPN患者过度的外部FPA，从而为非创伤性下肢截肢损害级联的早期康复干预创造了一种潜在的策略。我们拟议的研究旨在提高对导致成人DMPN患者外部FPA幅度增加的特定运动障碍的理解，以及这些障碍是否适合早期干预。目的：探讨糖尿病无周围神经病变(DM)、无糖尿病(CON)、糖尿病伴周围神经病变伴神经病理性足底溃疡病史(DMPN[+]NPU)、糖尿病伴周围神经病变无神经病理性足底溃疡病史(DMPN[-]NPU)患者的FPA特征。目的2：确定选择下肢关节变量预测FPA幅度的能力；目的3：确定降低FPA对糖尿病患者FPA幅度过大个体足底内侧峰值压力的影响。预期结果：我们假设，在患有DMPN的成年人中，足部、脚踝和髋关节活动受限是导致外部FPA幅度过大的重要原因。我们还假设，在指导之后，患有DMPN的参与者可以故意减少他们的FPA，导致伴随而来的内侧足底峰值压力的降低。

DESCRIPTION (provided by applicant): The long-term objective of this research is to determine the contribution of foot progression angle (FPA), a spatial gait variable that represents foot rotation in the transverse plane, to the development of neuropathic plantar ulcers in adults with diabetes mellitus and peripheral neuropathy (DMPN). Clinical Significance: There are approximately 80,000 non-traumatic lower extremity amputations annually in the United States, 84% of which are preceded by neuropathic plantar ulcers. Adults with DMPN are at high risk for neuropathic plantar ulceration secondary to increased peak plantar pressure under bony prominences on an insensate foot. Therefore, peak plantar pressure is frequently used as a proxy measure of risk for skin breakdown and subsequent non-traumatic lower extremity amputation. Preliminary studies suggest a direct relationship between excessive external FPA and the timing and magnitude of medial peak plantar pressure in children with neurological pathology and in adults with DMPN. Given that adults with DMPN have nearly three times the rate of functional mobility deficits associated with lower extremity impairment than their healthy counterparts, it is imperative to improve our understanding of the contribution of excessive external FPA to the impairment cascade of excessive medial peak plantar pressures, medial neuropathic plantar ulceration, and non-traumatic lower extremity amputation. Unexplored areas of research: Despite the strong relationship between excessive external FPA and plantar pressure, to our knowledge there are no studies that have examined joint mobility limitations that contribute to FPA in individuals with DMPN. Furthermore, there are no studies probing whether excessive external FPA can be reduced in adults with DMPN, thereby creating a potential strategy for early rehabilitation intervention in the non-traumatic lower extremity amputation impairment cascade. Our proposed research seeks to improve understanding of specific movement impairments that contribute to increased external FPA magnitude in adults with DMPN, and if those impairments are amenable to early intervention. Aim 1: Determine the characteristics of FPA in groups of subjects with diabetes mellitus without peripheral neuropathy (DM only), without diabetes mellitus (CON), with diabetes mellitus and peripheral neuropathy WITH a history of neuropathic plantar ulcers (DMPN [+] NPU), and with diabetes mellitus and peripheral neuropathy WITHOUT a history of neuropathic plantar ulcers (DMPN [-] NPU). Aim 2: Determine ability of select lower extremity joint variables to predict FPA magnitude; Aim 3: Determine the effect of reducing FPA on medial peak plantar pressure in individuals with diabetes with excessive FPA magnitude. Expected outcomes: We hypothesize that foot, ankle, and hip joint motion limitations contribute substantially to excessive external FPA magnitude in adults with DMPN. We also hypothesize that after instruction, participants with DMPN can intentionally reduce their FPA, resulting in concomitant decreases in medial peak plantar pressure.